Cognitive status of patients with coronary artery disease and concomitant atrial fibrillation

De V.A., Batyukina S.V., Kochetkov A.I., Klepikova M.V., Konik V.A., Ostroumova O.D.

1) Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 2) City Clinical Hospital n.a. F.I. Inozemtsev of the Moscow Healthcare Department, Moscow, Russia; 3) I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

Background. Cognitive impairment (CI) is a public health problem. Multimorbid patients with coronary artery disease (CAD) and atrial fibrillation (AF) are at higher risk of developing CI, which can lead to poorer quality of life, difficulty in adherence to medications, and a higher incidence of adverse drug reactions.
Objective. Assessment of cognitive functions (CF) in CAD patients depending on the presence of concomitant AF and bleeding.
Methods. The study included 150 patients ≥18 years of age with CAD, who were divided into 2 groups depending on the presence of concomitant AF: Group 1 – 77 CAD patients who received clopidogrel and acetylsalicylic acid (ASA) without AF (15 [20, 5%] women, mean age – 63 [57; 71] years), group 2 – 73 CAD patients with AF treated with clopidogrel and rivaroxaban/apixaban (15 [20.6%] women, mean age – 70 [61.5; 74.0] years). All patients underwent a retrospective assessment of hemorrhagic complications using a special questionnaire and assessment of CF using a number of neuropsychological tests: Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Trial Making Test (TMT, part A, B), Word Fluency Test, Word-List Recall Test, Stroop Color-Word Conflict Test.
Results. Among CAD patients with concomitant AF, there were statistically significantly fewer people with MMSE score 28–30 points, in contrast to CAD patients without AF (18 (24.3%) versus 33 (42.9%), respectively, p=0.003). Also, patients with concomitant AF spent statistically significantly more time completing Stroop test part 3 compared to CAD patients without AF (190 [153; 225] and 159 [122; 218.5], respectively, p=0.048). When analyzing the CF of patients depending on the presence of bleeding, the only statistically significant difference was revealed - patients without bleeding spent statistically significantly more time completing TMT part A than patients with a history of bleeding (100.3 [75; 125] versus 87.4 [63.8; 102.8], respectively, p=0.015).
Conclusion. The results of the neuropsychological study indicate an unfavorable effect of concomitant AF on the CF state of patients with CAD.

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About the Authors

Corresponding author: Olga D. Ostroumova, Professor, Dr. Sci.(Med.), Head of the Department of Therapy and Multimorbid Pathology n.a. Academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education; Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ostroumova.olga@mail.ru

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